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Thanks to Dr. Mattia Barbareschi, MD, Trentino Biobank (Italy), for contributing this case. To contribute a Case of the Week, follow the guidelines on our Case of the Week page.

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Case of the Week #287

Clinical History:
A 71 year old man with recent history of meningitis presented with recurrent episodes of pneumonia. High resolution CT scans showed "crazy paving" and "tree in bud" images. The patient underwent a transbronchial biopsy.

Discussion:
Aspiration of particulate matter, traditionally observed at autopsy, has also been described in debilitated patients, who often have a history of recurrent pneumonia (Am J Surg Pathol 2007;31:752), which is often unrecognized (Am J Surg Pathol 2010;34:1456). It usually (88%) shows bronchiolitis obliterans-organizing pneumonia, often with multinucleated giant cells, acute bronchopneumonia / bronchiolitis, or suppurative granulomas. Foreign material is usually, but not always (Am J Surg Pathol 2011;35:426) present.

Lipoid pneumonia is often an incidental post-mortem finding associated with debilitating disease. The lipid may be exogenous (from nasal sprays or inhalation of other lipid containing substances) or endogenous (bronchial obstruction).